<!DOCTYPE html>
<html>
<head>
<title>Roommate Application Form</title>
<link href="https://fonts.googleapis.com/css?family=Roboto:300,400,500,700" rel="stylesheet">
<link rel="stylesheet" href="https://use.fontawesome.com/releases/v5.5.0/css/all.css" integrity="sha384-B4dIYHKNBt8Bc12p+WXckhzcICo0wtJAoU8YZTY5qE0Id1GSseTk6S+L3BlXeVIU" crossorigin="anonymous">
<style>
html, body {
min-height: 100%;
}
body, div, form, input, textarea, p {
padding: 0;
margin: 0;
outline: none;
font-family: Roboto, Arial, sans-serif;
font-size: 14px;
color: #666;
line-height: 22px;
}
h1 {
position: absolute;
margin: 0;
font-size: 32px;
color: #fff;
z-index: 2;
}
.testbox {
display: flex;
justify-content: center;
align-items: center;
height: inherit;
padding: 20px;
}
form {
width: 100%;
padding: 20px;
border-radius: 6px;
background: #fff;
box-shadow: 0 0 10px 0 #cc0052;
}
.banner {
position: relative;
height: 210px;
background-image: url("/uploads/media/default/0001/01/f1cf9a9068f4bfbdbd9758c45db79203579a3561.jpeg"); background-size: cover;
display: flex;
justify-content: center;
align-items: center;
text-align: center;
}
.banner::after {
content: "";
background-color: rgba(0, 0, 0, 0.4);
position: absolute;
width: 100%;
height: 100%;
}
input, textarea {
margin-bottom: 10px;
border: 1px solid #ccc;
border-radius: 3px;
}
input {
width: calc(100% - 10px);
padding: 5px;
}
textarea {
width: calc(100% - 12px);
padding: 5px;
}
.item:hover p, input:hover::placeholder {
color: #cc0052;
}
.item input:hover, .item textarea:hover {
border: 1px solid transparent;
box-shadow: 0 0 6px 0 #cc0052;
color: #cc0052;
}
.item {
position: relative;
margin: 10px 0;
}
.btn-block {
margin-top: 10px;
text-align: center;
}
button {
width: 150px;
padding: 10px;
border: none;
border-radius: 5px;
background: #cc0052;
font-size: 16px;
color: #fff;
cursor: pointer;
}
button:hover {
background: #ff0066;
}
@media (min-width: 568px) {
.name-item, .contact-item {
display: flex;
flex-wrap: wrap;
justify-content: space-between;
}
.contact-item .item {
width: calc(50% - 8px);
}
.name-item input {
width: calc(50% - 20px);
}
.contact-item input {
width: calc(100% - 12px);
}
}
</style>
</head>
<body>
<div class="testbox">
<form action="/">
<div class="banner">
<h1>Roommate Application Form</h1>
</div>
<div class="item">
<p>Name</p>
<div class="name-item">
<input type="text" name="name" placeholder="First" />
<input type="text" name="name" placeholder="Last" />
</div>
</div>
<div class="contact-item">
<div class="item">
<p>Email</p>
<input type="text" name="name"/>
</div>
<div class="item">
<p>Phone</p>
<input type="text" name="name"/>
</div>
</div>
<div class="item">
<p>Student Status</p>
<input type="text" name="name"/>
</div>
<div class="item">
<p>Roommate Preferences</p>
<textarea rows="3" required></textarea>
</div>
<div class="item">
<p>Pet Restrictions</p>
<textarea rows="3" required></textarea>
</div>
<div class="item">
<p>If you are looking for property to share, describe below the neighborhoods you are interested in, the amenities, utilities, etc.</p>
<textarea rows="3" required></textarea>
</div>
<div class="item">
<p>If you are looking for a roommate to share your property, describe below the property, furnished or unfurnished, and amenities</p>
<textarea rows="3" required></textarea>
</div>
<div class="item">
<p>Monthly Rent and Utilities</p>
<input type="text" name="name"/>
</div>
<div class="item">
<p>Please provide any other pertinent information</p>
<textarea rows="3" required></textarea>
</div>
<div class="btn-block">
<button type="submit" href="/">APPLY</button>
</div>
</form>
</div>
</body>
</html>